World Health Organization Archives - InnoHEALTH magazine

Classification of Inter-Ictal Epileptic Seizure using combined Machine Learning and Deep Learning Approach

InnoHEALTH magazine digital team — Fri, 24 Jun 2022 08:45:25 +0000

Epilepsy is the most rarely recognizable neurological disorder characterized by an enduring predisposition to exaggerate recurrent seizures and that fatally affects the individual.

Prediction of Epileptic seizure is recently blooming as the most challenging task in order to amend the life of a patient. Specially, the inter-ictal state of Epilepsy needs more diagnostics attention for its unpredictable interrupted properties. In order to analyze the EEG recordings, various machine learning techniques have been implemented but many of them lack in bringing the brain network analysis into account which is the most vital way to predict, diagnose and detect the neural disorder with its level best accuracy. In this paper, EEG signals are collected from an open source and preprocessed by using Discrete Wavelet Transform where the features are extracted. In the next step, the features are transformed into a robust multi-dimensional array retaining its spatial properties. In the succeeding step, the array sequence is fed to a Deep Convolutional Neural Network to classify the disease using the training data.

A Detailed Description on Epileptic Seizure

Epilepsy is the most rarely recognizable neurological disorder characterized by an enduring predisposition to exaggerate recurrent seizures and that fatally affects the individual. Any abnormal neural activity localized in the cerebral cortex is called epileptic seizure (ES). The seizure causes the normal brain network to evoke neurons in a self-sustained hyper-synchronized manner and ultimately affects cognitive function. According to a survey of World Health Organization (WHO), 70 million people worldwide are suffering from epilepsy trails, however recognized as most rarely detected brain dysfunction. The task of detecting or predicting ES is still a concerned research since the past three decades. Inter-ictal ES emerges from random spikes, slow yet sharp complex neuro waves which is different from clinically observed ES and mostly the symptoms are observed in children. However, the automated detection and prediction algorithms depending on electroencephalographic (EEG) measurements are characterized for the transition of signals from the inter-ictal to the ictal state by identifying the image patterns significantly. Therefore, the baseline inter-ictal properties are vital. However, many inherent assumptions are commonly implicated to monitor the EEG activity during this inter-ictal state which is relatively constant and interrupted during seizure occurrence.

To determine the type of seizure and brain areas involved, an Electroencephalogram (EEG) is performed. EEG has various unparalleled properties for its immense usages to study ES such as signals are recorded with high temporal resolution and low cost, and systems are capable of both long term and portable monitoring. Capitalizing on the specific properties of EEG, a number of EEG based approaches have been developed for the automatic prediction of epileptic activity. The analysis of EEG signals for the purpose of ES detection and prediction have been advanced with the help of the most efficient machine learning technique such as Brain Network analysis. Networks in a regular, lattice-like configuration are characterized by high clustering and a long average path length. In recent longitudinal studies, we are more concerned about graph-based brain network analysis, in which the nodes in the graph are represented by the electrodes while the links are defined by the measure of association between the nodes. Accordingly, we found increases in average clustering and path length and decreased weight dispersion indicating that normal brain maturation is characterized by a shift from random to more organized small-world functional networks. However, this analysis is receded for the reason that it required the entire graphical data to be processed simultaneously which is less effective for the graphs with billions of nodes and edges.

To address the above challenges, the present investigation has sought to develop a novel prediction strategy for seizure detection based on Neural Network (NN) analysis during inter-ictal state of seizure.

To address the above challenges, the present investigation has sought to develop a novel prediction strategy for seizure detection based on Neural Network (NN) analysis during inter-ictal state of seizure. We have considered the ES data, remove the random noises from the data by using Discrete Wavelet Transform (DWT) and then convert them into more robust multi-dimensional array tensors and obtain a sequence whose topology retains spatial information. Once all the frameworks of sequences are gathered, they are fed into D-CNN for classification. ES is predicted by inter- and intra- individual generalized properties.

1. Preprocessing of Data

The dataset being used in this paper are imported from CHB-MIT open source contains scalp EEG data of 23 patients recording 844 hours of seizure occurrence facing total 163 seizures.

Fig. 1 Data captured using 22 electrodes at sampling rate of 256 Hz.

Fig. 2 Tree structure of DWT

Fig. 3 Framework of the proposed system

In Fig. 2 the tree structure of DWT is shown where the original image is decomposed in time domain using a high pass filter (HPF) and a low pass filter (LPF) sequentially. Later on, it is down sampled by 2 to calculate each level using the coefficient values.

This experiment follows two major steps; primarily data processing and followed by a classifier. In data processing, the original images obtained from patients are extracted using DWT. In the second step, the preprocessed data is fed to D-CNN for the prediction of epilepsy.

The proposed technique

Fig. 4(a) 2-DCNN Model

The architecture of D-CNN was predominantly developed in 80’s. The technique is updated and refined periodically and becomes the most improved deep learning method during the 21st century. The latest version of D-CNN is unwrapped as compared to earlier known neural networks. The trending technique occupies a multi-layered architecture well compatible in the domain of digital image processing, computer interfaced medical imaging and medical image analysis. It commands significantly with high resolution spatial image approachable for prediction, classification and segmentation problems. The block of D-CNN has multiple Convolutional layers, pooling layers and one fully connected layer as shown in figure 4 (a) and (b) depicting two different layered CNN models such as 2-DCNN and 4-DCNN respectively.

Architecture of 2-DCNN model is the combination of two similar types of DCNN models comprises of a kernel size (3×3) with 32 filters each. The pooling layer has a pool size of (2×2). Its activation function is known as softmax activation function.

The 4-DCNN model is the combination done by a simple concatenation of the two similar 2-DCNN models with softmax as activation function.

To validate the efficacy of the classifier, four types of desire classes are distinguished such as True Positive (TP), False Positive (FP), True Negative (TN) and False Negative (FN).

Fig. 4(b) 4-DCNN Model

Fig. 5 Confusion Matrix to classify the seizure

Performance index of the classifier is validated by considering the values of confusion matrix.

TP: These are the accurately predicted positive values interpreting the actual class to be true and the predicted class to be true.
TN: These are the accurately predicted negative values interpreting the actual class to be false and the predicted class to be false.
FP: When the actual class is false and the predicted class is true.
FN: When the actual class is true but the predicted class is false.

Further analysis on the matrix is performed by the following formulas such as:

In the future, predicting onset seizures can be further improved by reducing the training time and thereby, allowing doctors to diagnose the disease more quickly in an organized manner.

In the future, predicting onset seizures can be further improved by reducing the training time and thereby, allowing doctors to diagnose the disease more quickly in an organized manner. Therefore, future research should be conducted to reduce the number of parameters available in the model. This research work needs to be extended by adding Electromyogram (EMG) Electrocardiogram (ECG) data, implicating simplified feature extraction techniques and improving the number of supervised and unsupervised classifiers.

Composed by: “Prateek Pratyasha is presently pursuing Ph.D. under the department of Biomedical Engineering at National Institute of Technology Raipur. Her areas of research are cognitive recognition, neural plasticity, artificial intelligence and Optogenetics.”

“Dr. Saurabh Gupta is an Assistant Professor of Biomedical Engineering, at National Institute of Technology Raipur. His primary areas of research are inverse problems, medical imaging and stochastic optimization, to develop technologies for community medicine and public health. “

The post Classification of Inter-Ictal Epileptic Seizure using combined Machine Learning and Deep Learning Approach appeared first on InnoHEALTH magazine.

An Informed Decision – Responsibility of One Towards Oneself

InnoHEALTH magazine digital team — Tue, 28 Sep 2021 08:57:02 +0000

An overview of all the different avenues for a career in that subject, it would ignite a sense of passion and excitement in the students

Pursuing a career in Medical Sciences in India requires the student to undertake M.B.B.S, a five year long rigorous and comprehensive course which transforms them into young healthcare professionals of tomorrow. However, a significant aspect missing from almost all the components is the students’ approach, curriculum, teaching, etc, alongwith a guidance for different career avenues within and beyond the domain of healthcare, which one could pursue after their graduation. An enlightenment on the measures we, as members of the medical fraternity, can adopt so as to better enlighten students, who are at different stages of their graduation journey, about the different career avenues for them, in order to make a responsible decision about their future. For young undergraduate students, stepping into the campus of their medical colleges infuses them with a sense of pride and excitement. The days and nights of hard work gone into preparing themselves for the National Eligibility cum Entrance Exam (N.E.E.T) have finally paved their way to the journey of becoming doctors. Well, that’s what we all dreamt of as an above average student in school and that’s what we intend to do in the five years we spend there. The medical curriculum of India is globally renowned to be one of the most robust and comprehensive ones. Apart from imparting vast loads of knowledge to the students somewhere we have forgotten to impart the wisdom they need to make tough choices ahead?

The seeds of this issue are sown right in the early days of our secondary education. The teachers and the ability of the student to identify his/her preferred career choice are the factors that significantly influence the career decision and aspirations of students. However, anyone with an ability to study long hours and have interest for biology over other subjects is prophesied by the parents, teachers and colleagues to enter the profession of medical sciences, or sometimes even the fact that the parents own a private hospital set up, is an incentive enough for children to pursue this career option. Are these criteria adequate for a young, naive mind to make such a huge life decision? Can a mere inclination towards biology or dislike for mathematics make one competent enough to understand whether one would prefer a career in healthcare? The crucial career path of each professional should be well in various fields when making career choices, and if yes, can the school administration help in enabling such a collaboration? Events such as career camps should be organized at the school level; or at least one interactive session a week about different career paths can be conducted for secondary and higher secondary school students, helping them navigate through the same.

An enlightenment on the measures we, as members of the medical fraternity, can adopt so as to better enlighten students

The significance of “meticulous formative early years” in all domains of education is highly underrated. As soon as the students enter their medical colleges, they perceive the curriculum to be one which aims to inculcate in them the aptitude of a good healthcare professional. Secondly, they believe it would make them knowledgeable enough to score well in the NEET-Post Graduate (P.G.) exam, which would enable them secure a seat in the specialty and institute of their choice. However, I believe that merely a good education and good score in the entrance exams is not the main aim of MBBS. We often miss out on the most crucial aspect – exploration! Why do we assume that NEET-PG is the only exam an MBBS graduate is eligible for? While a good education will enable one to score well in the entrance exam, how would one acquire the wisdom of what area one should choose to specialize in? Graduating in medical sciences opens a vast array of opportunities and having a closed mind to those different possibilities and the sheer lack of knowledge about their existence is a major hurdle in making the best of M.B.B.S. The merit list rank and prestige associated with a field are insignificant criteria that unfortunately end up influencing this decision in most cases.

In the very first week of the semester, before the lectures begin, if the faculty members of respective departments would give an overview of all the different avenues for a career in that subject, it would ignite a sense of passion and excitement in the students, while also understanding the significance and contribution of the subject to the field. A small step like urging students to report and publish rare cases they encounter during their clinical postings would give them the incentive to dive deeper into all different aspects of the case and the specialty, thus providing a glimpse of what the field has to offer. If included in the medical curriculum, small initiatives such as educational orientation tours to the college’s animal house or being a part of a drug trial could get one excited to specialize in Pharmacology and Drug Development.

Participation in workshops and drives like those of Cardiopulmonary resuscitation (CPR) and Trauma Management could make students want to pursue Critical Care Medicine or Trauma Surgery and participation in Mock Health Parliaments could make one consider a career in Community Medicine and Organizations like the World Health Organization. An experience of participating in symposia and seminars could raise interest in subjects with significant academic aspects like Physiology, while involving a student in a single interesting case could make one consider the less preferred branches like Forensic Medicine and Toxicology. One must remember that the aim of MBBS is not to transform students into masters of all specialties; instead, it is to give a sneak-peak into what each specialty has to offer, and simultaneously build a good personality and develop an ethical approach to life. Inspiration can come from literally anywhere, and once it strikes, the impact can be life-altering. While the compulsory rotational internship does provide a small glimpse into this area, it is neither sufficient, nor can one devote the appropriate amount of time for this, owing to the pressure of preparation for the entrance exams.The recently introduced Competency Based Medical Education curriculum and NEET examination give a glimmer of hope in this context and its impact remains to be seen.

From a career in medical research to joining the armed forces, the opportunities are immense and we are only limited by our hesitation to explore them beyond the conventional approach of our formative training years.

The scope of graduation in medical sciences extends beyond the domain of healthcare. Students could also have a career in Bioethics and Medical Law; they simply need to immerse themselves in the bioethics’ way of thinking, writing, or attend conferences from this field. Administrative experience, such as that of being a part of the student council, might inculcate the desire to pursue a career in the Indian Administrative Services, whereas participation in Model United Nations could prompt one to take up a career in diplomacy. The COVID-19 pandemic has highlighted the importance of Hospital Management, stimulating more students to consider a career in the same. It has also led our policy makers to understand the importance of background knowledge in health sciences for taking administrative decisions in the healthcare sector, giving an additional push towards the creation of Indian Medical Services, to apply for which a bachelor’s degree in medical sciences (M.B.B.S) would be a mandatory requirement. Indulging in literary activities could open doors in careers like Medical Journalism. From a career in medical research to joining the armed forces, the opportunities are immense and we are only limited by our hesitation to explore them beyond the conventional approach of our formative training years. Understanding the need for it, if the curriculum could itself incorporate these aspects, young medical graduates would be in a better position to make Informed Decisions regarding their future, and in turn, serve the society in a much better way.

“Dr. Alhad Mulkalwar is presently working as an Intern (M.B.B.S.) at Seth G.S.M.C. and K.E.M. Hospital, Mumbai, India. He has won many international and national accolades.”

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Post Antibiotic World

InnoHEALTH Magazine — Mon, 18 Nov 2019 09:25:20 +0000

Like the ‘guardians of the galaxy’ the futuristic prospect of this world will be a place where the microbes have become resilient against antibiotics and the fight against infection has ceased to find its way through antibiotics. Though most of the antibiotics that are consumed are metabolized by the body, a negligible amount is passed through us as waste, which is further carried to wastewater treatment plants.

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The basic methodology to clean the wastewater in plants is through membrane bioreactor that uses both biological as well as filtration process where bacteria are acclimatized to consume the waste products and help in metabolization. The antibiotic waste breakdown by bacteria often expresses resistance genes that reduce the effectiveness of the medicines. In the long run, the horizontal gene transfer develops whose expression pass from one generation to the next and the resistance genes gain prominence over the years. With the passing phase, the bacteria grow and thrive itself therefore often giving rise to biomass. The biomass is produced in tonnes by wastewater plants nearly every day. After treatment, they are often disposed of as landfills, fertilizers for agriculture and feed crops for livestock. A minute quantity of resistant bacteria and free-floating DNA often finds its way through effluent of the pharmaceutical industries. The studies have further shown that gene elements called plasmids carry resistance genes for several different types of antibiotics, therefore, resulting in a positive correlation between one type of antibiotic and the resistance gene of another. It creates a dangerous dormant situation that can erupt like an active pandemic under the favourable situation. Plasmids are a thousand times smaller than bacteria and their free-floating nature often surpasses the treatment barriers of the filtration system of the treatment process, therefore making exit through effluents. They further contaminate the surface water and groundwater – the two important sources of drinking water. Researchers have found that even low concentrations of just a single type of antibiotic in the water supply leads to resistance in multiple classes of antibiotics and hence leads to antimicrobial resistance (AMR).

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Water, as we all know, is the utmost need of our survival. Human body comprises around 60% water and the fact that less consumption of water leads to various diseases in the future. Apart from facts and figure, one simple question we often forget to inquire is where this water is coming from? Surface water i.e. lakes, rivers and ponds or groundwater i.e. tube wells, bore well, well as these are the two sources that give us a glass of water.

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Our health concern and the credulous brainwash of our mind by the various available water filter present scenario and save our planet from the harmful effect of self-made destruction.Effective treatment and management of wastewater from the pharmaceutical industry will help in overcoming antimicrobial resistance. Advanced treatment methods such as reverse osmosis, nano filtration, and membrane bioreactors have shown to be promising processes for cleaning micro pollutants with nano gram per litre (ng/L) concentration levels.The nation where the trial/testing of most of the antibiotic occurs, there are rarely any constraints implemented on the disposal of pharmaceutical wastewater to the surface water. The current scenario of environmental issue foresees that in the near future there will be scarcity of drinking water and our hope was restored when global challenge was taken to in the market often diverts us from our prime concern of keeping our planet safe from water pollution. The pollution of water bodies has been initiated by us and still we are invariably helping it grow with every passing day. As discussed earlier, the various point sources from domestic to industrial pave the way for antibiotic to contaminate the water bodies. According to the latest report of UNICEF, 2.1 billion people lack the access to clean and safe drinking water.

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How do we remove the problem? What do we do to save ourselves from the harmful effects?

The encouraging words of Normal Vincent Peale, American author ‘Every problem has in it the seeds of its own solution. If you don’t have any problems, you don’t get any seeds’ gives us the hope that we will successfully overcome the present scenario and save our planet from the harmful effect of self-made destruction.Effective treatment and management of wastewater from the pharmaceutical industry will help in overcoming antimicrobial resistance. Advanced treatment methods such as reverse osmosis, nano filtration, and membrane bioreactors have shown to be promising processes for cleaning micro pollutants with nano gram per litre (ng/L) concentration levels.The nation where the trial/testing of most of the antibiotic occurs, there are rarely any constraints implemented on the disposal of pharmaceutical wastewater to the surface water. The current scenario of environmental issue foresees that in the near future there will be scarcity of drinking water and our hope was restored when global challenge was taken to curb the antimicrobial resistance from environment. Remedial measures taken towards eradication are further discussed.

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Political commitments: International efforts: World Health Organization Jaipur declaration on antimicrobial resistance 2011 recognized AMR as a serious public health threat. With the 2014 WHO Report, the extraordinary rates of AMR prevalent in India came into focus. After this report, joint efforts were made by India and WHO. While WHO labelled AMR as the Flagship Priority area for South East Asia Regional Office (SEARO), the Indian Medical Association launched an awareness programme to train the physicians and sensitize the general public. In 2015, the 68th World Health Assembly decided to incorporate the concept of One Health in the fight against AMR and a Global Action Plan was initiated. All member countries, including India, agreed to frame their own National Action Plans (NAPs) for AMR by 2017.

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National efforts: The Government of India formulated a Core Working Group on AMR that drafted a NAP for the country. Six strategic priorities were listed in NAP, all of which incorporated considerations for AMR in the environment, directly or indirectly. Further, each strategic priority has defined interventions, activities and outputs, the fulfillment of which is delineated by a timeline projected for the next five years. The NAP, although promising, has not yet come into full action in any of the Indian states so far. To curtail the prevalent malpractice of over-the-counter (OTC) sale of drugs, the Central Drugs Standard Control Organization implemented Schedule H1 in India in 2014. It, however, encompasses only a few selected antimicrobial groups. In June 2017, the Food Safety and Standards Authority of India (FSSAI) published the list of maximum residue levels for antimicrobials in foods prepared from animal, poultry and fish.

Health Organization in India: To know the near-exact extent of AMR, AMR surveillance networks were initiated by the Indian Council of Medical Research (ICMR) and the National Centre for Disease Control (NCDC) in 2013 and 2014, respectively. In 2015, these two organizations along with the support from Centers for Disease Control and Prevention (CDC) USA, started a systematic assessment of the prevailing IPC practices in India with the aim of formulating new guidelines for preventing hospital-acquired infections.

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These activities, however, cater basically to the emerging AMR in the healthcare settings and do not include special provisions for AMR in the environment. Similarly, the National Health Mission’s National Health Systems Resource Centre and the National Accreditation Board deal with IPC practices and strengthening of laboratories/hospitals and not with the AMR in the environment per se. The importance of AMR in the environment has been realized recently by the national health authorities and The National Health Policy 2017 calls for a rapid standardization of guidelines regarding antibiotic use, limiting the use of antibiotics as OTC medications, banning or restricting the use of antibiotics as growth promoters in animal livestock, and pharma co-vigilance including prescription audits inclusive of antibiotic usage – in the hospital and community.

Innovative ideas: The National Health Mission of India started the Swachh Bharat Abhiyan or the Swachh India Mission to improve the basic hygiene and sanitation in all spheres of life. As a part of this massive programme, education was imparted through mass media on the health hazards of open defecation. UNICEF data shows that out of one billion openly defecating people in the world, 60 percent reside in India. It is further argued that it is a behavioural problem with the Indians as other poverty struck nations of Africa and South East Asia did not have the problem of open defecation to this an extent. To deal with such socio-cultural issues, innovative ideas along with mass media are needed in India.

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So far in India, antimicrobial resistance in the environment has been a topic of least priority. With an ever-increasing threat of AMR in the environment, immediate action is required to halt its progress and spread. A combined effort of multidisciplinary and multi-sectoral approach will be able to eradicate the problem in the near future.

About the author

Dr. Debleena Bhattacharya is an independent researcher. She is presently working as an Assistant Professor in the Department of Environmental Science and Engineering at MEFGI, India. She holds a doctoral degree in Environmental Science from IIT (Indian School of Mines) Dhanbad (India). Her specialisation is in the field of wastewater treatment and biotechnology.

The post Post Antibiotic World appeared first on InnoHEALTH magazine.

Health and Oral Health Diseases

InnoHEALTH Magazine — Thu, 14 Nov 2019 11:06:01 +0000

Well, many of them must be wondering how that can be possible. But if we look over the past 2-3 decades, the mortality rate has increased to its next level, obesity being one of the rising causes. In 1990, the World Health Organization considered obesity as a global epidemic. And guess who made it go globally that vast? We humans did. Irregular eating habits, irregular sleep patterns, stressful life and not maintaining overall health is leading to an unsatisfactory life.

Talking about obesity, what is more important for the body? Nutritionist are vital to human development and maintaining health. 7 essential nutrients a body needs are water, carbohydrates, proteins, amino acids, fats, vitamins, minerals and omega-3 fatty acids.

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What exactly is obesity and why is it an important topic that everyone should be aware of? In simple terms, it means abnormal or excessive fat accumulation that may impair health. And it is an important concept in our day-to-day lives because of health consequences. Thus, in today’s generation an individual’s life is more interconnected to one’s personality, lifestyle, socioeconomic status, and social interactions.

Recently heard of benign obesity? It is a term sometimes used to describe a condition in which an individual is overweight or obese but does not suffer from any co-morbidities, such as diabetes, hypertension etc. Our daily lifestyle choices have a direct connection to whether or not a person is prone to facing obesity.

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Asking about if obesity is hereditary? Then, genes aren’t the most worrisome risk of obesity. An individual’s upbringing can be, the way the family raises, the daily food intake, importance placed on physical activity and how a person would take their behaviour model, are the bigger influences on likelihood of obesity than genes. Health is not valued till sickness comes, true isn’t? Obesity is not because it runs in the family!! It is because no one runs in the family!!!

Today, more than 95% of all chronic diseases is caused by food choice. Yes,being overweight is linked to a number of health and oral health diseases, including: heart disease, high blood pressure, diabetes, cancer, gallbladder and gallstones, breathing problems, such as sleep apnea (when a person stops breathing for a short time during sleep) and asthma, oral health problems such as caries, halitosis, poor oral hygiene, periodontal disease. Symptoms for obesity include breathlessness, Increased sweating, snoring, inability to cope with sudden physical activity, feeling tired, back and joint pain, low confidence and self-esteem, and feeling isolated.

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After being aware of the risks, proper health and oral hygiene should be maintained. And why is maintaining diet an important factor? Because a poor diet may result in lack of essential nutrients and vitamins thus potentially making it more difficult for your body to fight off an infection. A diet high in fat and calories, including large quantities of processed foods or sugar, and lack of physicalactivity, leads to obesity. Those same foods can cause oral health problems including gum disease, premature tooth loss and bad breath Our body craves for what is in our bloodstream. Wheat, sugar, alcohol, coffee and de-vitalized foods are designed to be addictive. Sugar being addictive – agreed. But how does sugar affect an individual’s health and oral health? Well, consuming sugar is bad for an individual, but consuming too much has become a norm and that can cause health issues. The only type of sugar the body needs is glucose, which it can make by breaking down carbohydrates, proteins and fats. When ingested, simple sugars are converted into plaque if not removed immediately. As plaque begins to accumulate on our teeth and gums, the risk of varying forms of gum diseases such a gingivitis and periodontitis, as well as tooth decay, may become inevitable.

In 2018, a study revealed that 170 children and young people have rotten teeth removed every day, undergoing general anaesthesia. That’s an unpleasant operation that is completely avoidable; we have got a lot of evidence to show that the main cause is excessive sugar. There are also links with type 2 diabetes, usually chronic disease seen in adults, but we are seeing more and more under the age of 25 these days.

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So, what an oral health care professional should be aware of? Dentists must be aware of how nutrition impacts general and oral health, and how dental treatment can impact patient’s nutritional status. Oral health is strongly influenced by the daily intake of food; on the other hand, oral health can also play a significant role in nutritional intake and general health status. The dental caries is also a chronic disease and may be depend on oral hygiene, high intake of sugar added to food, lifestyle factor, and host factors (salivary flow, buffer capacity and buccal microflora). Relationship between obesity and gum disease – we actually don’t know if this is a one-way or a two-way street. For example, conditions like diabetes, the relationship is bilateral. Periodontal disease will affect diabetes and diabetes will worsen periodontal disease, so that could be a possibility here. What are the other reasons of obesity affecting gums and what would be its risk factors? Because of various dietary habits and improper maintenance of oral hygiene, chronic periodontal infection is an inflammatory state that is described by a deviation in microbial environment and composition of subgingival plaque bio films and accelerated destruction of tooth supporting structures. Thus, low glycaemic diet may be beneficial to our oral health. Periodontal diseases are also influenced by various risk factors including aging, smoking, oral hygiene, socio-economic status, psycho social stress, osteopenia, osteoporosis and various systemic diseases, which signifies that periodontitis does not merely occur as a consequence of plaque deposition but is also coupled with various other host factors. Also, on examination, obese adolescents exhibited multiple carious teeth, higher plaque index, gingival inflammation, bleeding on probing and probing depth compared to normal weight subjects of similar age.

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An obese patient, whose lungs are often not large enough to lift heavy chest walls, can have trouble during breathing, especially when active. Also, during sleep the person might breathe through his/her mouth instead of nose, thus jaw is forced into an unnatural position for a longer period of time. This can lead to teeth grinding and development of an overbite, over jet or spacing between the anterior teeth.How can we, as dentists, help the obese patients? Dentists should include the evaluation of BMI in routine patient examination and eventually refer obese periodontal adolescents for weight reduction interventions like diet therapy, behavioural therapy, pharmacotherapy, so that they can have better control over periodontal inflammation.What are the practical considerations in dentistry? It can be difficult carrying out dental care for an obese patient: the maximum lifting weight for modern dental chair is approximately 140kg (23 stones). The position of anatomical landmarks may be less obvious if surrounded by fatty tissue, the landmarks for placement of an inferior alveolar nerve block can be impossible to palpate through excess soft tissue. It may be impossible to palpate cervical lymph nodes in a large neck. Also due to constant secretion of saliva, the mouth and teeth are rinsed and kept free off food debris and foreign particles, thus excess of buccal pad of fat hinders with self-cleansing action in the mouth. Because of lack of saliva present in the mouth, it can lead to dry mouth. Sip water frequently throughout the day and use alcohol-free antiseptic mouthwash daily for cure. A normal sized mirror is unsafe for retraction of soft tissues: a ‘lax’ tongue retractor can be useful.What is the alternative to conventional dental chair? Refer the patient to the hospital environment where the patient may be treated on an operating table or trolley. Another possible solution for obese patients is a custom-made chair such as DIACO dental chair. What is the difficulty faced during conscious sedation? When thinking about conscious sedation for obese patients, the potential difficulties in airway management and intravenous cannulation should be considered. The provision of inhalation sedation with nitrous oxide during which oxygen levels are maintained at or above 30% may be more appropriate. If intravenous sedation with midazolam is proposed, the overall benefit to the patient must be carefully weighed up against the increased likelihood of significant respiratory depression and the difficulties in managing a respiratory complication. New research suggests that the health of your mouth mirrors the condition of your body as a whole. A healthy smile can surely transform our visual appearance and the positivity of our mind-set.

‘Eat every two hours, sleep eight hours, have plenty of water and pray to keep calm. Most importantly, carry a smile on your face.’

About the author

Dr. Vishaj S. Maru is a dental surgeon. She studied dentistry at the D.Y. Patil School of Dentistry. She does clinical practice in Mumbai with a keen interest in academia and clinical dentistry.

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Study: Increasing Protein and Dairy Intake Reduce Burden of Diabetes

InnoHEALTH Magazine — Mon, 11 Nov 2019 08:29:01 +0000

Increasing protein and dairy intake may help reduce burden of diabetes: A study

Diabetes – increase in blood glucose levels – is an emerging health problem, especially in developing countries. According to the World Health Organisation, India had 69 million diabetic individuals in 2015 and the number is projected to go up to 98 million by 2030. The problem is more serious for Asians as their genetic make-up puts them at a greater risk of diabetes at a younger age than their European counterparts.

If left untreated, diabetes can intensify to serious health conditions like blindness, kidney failure, heart problems, etc. Apart from genetic factors, the occurrence of diabetes is related to food preferences and lifestyles. Therefore, understanding the link between the consumption of various foods and the prevalence of diabetes in different states can help in devising effective strategies to address the problem.

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A new study has linked the food preferences of individuals to the prevalence of diabetes in various states of India. The study has found that eating calorie-rich food like sugar and honey increases the risk of diabetes while the addition of protein-rich food and dairy products in a meal can help reduce the risk of diabetes.

The study is based on data from the National Family Health Survey-4 (2015– 2016), 2011 census, data on per capita crop production, and consumption figures of different food groups from the 68th round of the National Sample Survey. It evaluated trends of food availability and preferences in various states with diabetes numbers.

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It was found that diabetes was more common in states like West Bengal and Kerala where people consume more non-vegetarian food than the one where the diet is predominantly vegetarian. This is because a vegetarian diet helps in diabetes management by making the body sensitive to the insulin hormone.

Researchers also noted that there were more diabetics in the states where people consumed more sugar and honey though this trend was not valid in the case of Maharashtra, Rajasthan, and Haryana. The study also found that eating protein-rich food such as pulses and nuts decreased the chances of diabetes. Similarly, states, where people ate more dairy products, had a low prevalence of diabetes.

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Diabetes, often dubbed as a lifestyle disorder, was also found to be high in urban districts than in rural areas. This is so because people in cities tend to be less physically active. This makes urbanization an important factor for the growing number of diabetics in the country. Also, diabetes was found to be more common in males than females as has been indicated in the earlier studies.

‘Our study has identified hotspot districts having a high prevalence of diabetes and recommended them to be targeted in public health programs,’ said Dr. Preeti Dhillon, author of the study and Assistant Professor at the International Institute for Population Sciences (IIPS), Mumbai. The analysis showed that 6.9% of adults in India between the age of 15-49 years have diabetes. Among the states and union territories, diabetes is highly prevalent in Andaman and Nicobar Islands, while the least in Rajasthan. The prevalence of disease was found to be more in districts that are close to the coastal areas. ‘The high prevalence of diabetes in Andamans and Lakshadweep is of interest as this has not been reported earlier and it would be worthwhile exploring whether any genetic or environmental factors contribute to this,’ commented Dr. V Mohan, Director, Madras Diabetes Research Foundation. Though he was not associated with the study.

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Dr. Anoop Misra, Vice President, Diabetes Foundation (India), commented that while this study provided new information about dietary context and prevalence of diabetes, it must be understood that diabetes is a multifactorial disease. Genetics, physical activity, alcohol consumption, and other lifestyle factors should be taken into consideration before establishing conclusive links. Food intake is a continuously changing and dynamic process and cannot be completely captured in a cross-sectional snapshot. He agreed, however, that high protein intake is needed for Indians as it boosts glucose metabolism in muscles reducing incidences of diabetes. The research team at IIPS included Koustav Ghosh and Gopal Agrawal apart from Dr. Dhillon. The results of this study have been published in the Journal of Public Health.

Credits: India Science Wire

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WHO's First Guideline to Digital Health Interventions

InnoHEALTH Magazine — Wed, 31 Jul 2019 09:46:27 +0000

On 17th April 2019, WHO released a ‘new recommendations on 10 ways that countries can use digital health technology, accessible via mobile phones, tablets and computers, to improve people’s health and essential services’. Harnessing the power of digital technologies is essential for achieving universal health coverage, says WHO Director-General Dr. Tedros Adhanom Ghebreyesus. Ultimately, digital technologies are not ends in themselves; they are vital tools to promote health, keep the world safe, and serve the vulnerable.

Over the past two years, WHO systematically reviewed the evidence on digital technologies and consulted with experts from around the world. This guideline is a roadmap to research for global health so as to strengthen countries health systems. It is to be effective, sustainable and responsible.

“The use of digital technologies offers new opportunities to improve people’s health,” says Dr. Soumya Swaminathan, Chief Scientist at WHO. “But the evidence also highlights challenges in the impact of some interventions.” She adds: “If digital technologies are to be sustained and integrated into health systems, they must be able to demonstrate long-term improvements over the traditional ways of delivering health services.”

Dr. Oommen John, Senior Research Fellow, George Institute says, India is a hub for digital health innovations, however very few of these innovations have achieved the scale for impact within the health systems. It is important therefore to pause, reflect and use the WHO digital health guidelines as framework of the innovation ecosystem in India and help guide energy and enthusiasm of the start-ups to develop, evaluate and implement digital health innovations that can help achieve the universal health coverage.

The guideline encourages policy- makers and implementers to review and adapt to these conditions if they want digital tools to drive tangible changes and provides guidance on taking privacy considerations on access to patient data.

“Digital health is not a silver bullet,” says Bernardo Mariano, WHO’s Chief Information Officer. “WHO is working to make sure it is used as effectively as possible. This means ensuring that it adds value to the health workers and individuals using these technologies, takes into account the infrastructural limitations, and that there is proper coordination.”

Mr. Mariano also said: “Digital Health is the future of healthcare. As we take the big leap into digital health, we must ensure that it is people centric, delivers positive health outcomes, does no harm to people and it actually improves the healthcare system as a whole.”

It is a ‘Living Guideline’ i.e. it will be updated regularly as new evidence becomes available. This Guideline has been completed under the newly formed section at the WHO: Norms and Standards section in the WHO. This Guideline has been regarding: Reproductive Health & Research and has four outcomes:

Health systems to have health data for accountability
Helping health workers to work efficiently
For tracking medical commodities to provide services
Making sure health coverage for all

Since it is a developing guideline and is meant to be stringent based on evidence alone; it is a path finder for a whole gamut of health issues. For each recommendation, a summary of the evidence on the positive and the negative effects has been provided.

Dr. Garrett Mehl, Scientist, Digital Innovation and Research, WHO says: “Digital interventions depend heavily on the context and ensuring appropriate design. This includes structural issues in the settings where they are being used, available infrastructure, health needs they are trying to address, and the ease of use of the technology itself.” Importantly, it must be noted that: “Digital health interventions are not sufficient on their own.”

The guideline recommendations about telemedicine, which allows people living in the remote locations to obtain health services by using mobile phones, web portals, or other digital tools. WHO points out that this is a valuable complement to face-to-face- interactions, but it cannot replace them entirely. It is also important that consultations are conducted by qualified health workers and that the privacy of individuals’ health information is maintained. The guideline emphasizes the importance of reaching vulnerable populations, and ensuring that digital health does not endanger them in any way.

Trusted Exchange Framework and Common Agreement (TEFCA)

On 19th April 2019, US Department of Health and Human Resources (HHS’) announced the next steps in advancing operability of health information by opening up the second draft of the Trusted Exchange Framework and Common Agreement (TEFCA) for public comment. TEFCA, would support the full, network-to-network exchange of health information nationally. Specifically, the documents being released for comments are: (1) a second draft of the Trusted Exchange Framework (TEF), (2) a second draft of the Minimum Required Terms and Conditions (MRTCs) for trusted exchange, and (3) a first draft of a Qualified Health Information Network (QHIN) Technical Framework. These documents will form the basis of a single Common Agreement that QHIN’s and their participants may adopt. This Common Agreement will create baseline technical and legal requirements for sharing electronic health information on a nationwide scale, across disparate networks.

“The seamless, interoperable exchange of health information is the key piece of building a health system that empowers patients and providers and delivers better care at a lower cost,” said HHS Secretary Alex Azar. “The 21st Century Cures Act took an important step towards this goal by promoting a national framework and common agreement for the trusted exchange of health information. We appreciate the comments and input from stakeholders so far and look forward to continued engagement.”

In developing a TEFCA that meets industry’s needs, HHS’ Office of the National Coordinator (ONC) for Health Information Technology focused on three high-level goals:

Provide a single “on-ramp” to nationwide connectivity
Ensure electronic information securely follows you when and where it is needed; and
Support nationwide scalability for network connectivity

ONC will maintain the TEF, while a non-profit, industry-based organization, known as the Recognized Coordinating Entity (RCE), will be awarded funds to develop, update, implement, and maintain the Common Agreement. Through this effort, ONC will define the minimum required terms and conditions needed to bridge the current differences among data sharing agreements that are preventing the flow of electronic health information. The industry-based RCE will be tasked with developing additional required terms and conditions necessary to operationalize the Common Agreement and meet the interoperability requirements of the 21st Century Cures Act.

“The updated Trusted Exchange Framework and Common Agreement we issued today considered more than 200 comments we received on our previous draft and reflects extensive work with our federal partners,” said Don Rucker, National Coordinator for Health Information Technology. “The future Common Agreement, made possible by the steps we take today, will provide the governance necessary to meet the interoperability demands of diverse stakeholders, including patients, healthcare providers, and health plans.”

The drafts released are responsive to stakeholder comments by making key changes to the draft requirements that health information networks who choose to participate would have to follow. These changes include updating the purposes for which information can be exchanged, adding a “push” method of data exchange, adding a technical framework for QHIN’s, and extending timelines for participating entities to implement changes that will be required by the Common Agreement.

These changes will help improve the flow of information between networks where needed and appropriate. In public health settings, for example, “reporting from providers is a foundational capability for effective public health action,” said Chesley Richards, Deputy Director for Public Health Scientific Services at the Centers for Disease Control and Prevention & that “The TEFCA will not only strengthen this capability, but will create the ability for timely and true bi-directional information sharing that is essential for responding to public health threats and epidemics.”

Designed to fill the gaps that currently impede the secure and appropriate flow of health information and to continue to enable the progress that has already been made in the private sector, the success of TEFCA depends on coordination with the private sector. “We expect that the implementation of the Trusted Exchange Framework and the Common Agreement, will bring us all that much closer to achieving the administration’s goals of nationwide interoperability,” said Dr. Rucker.

General Data Protection Regulation (GDPR), One Year On

It is a very recent piece of legislation in the European Union and the European Economic Area regions (continuation to the previous article on GDPR in InnoHEALTH volume 3 issue 1 Jan-Mar 2018). The GDPR was adopted on 14th April 2016, and became enforceable on 25th May 2018. As the GDPR is a regulation and not a directive, it is directly binding and applicable, but does provide flexibility for certain aspects of the regulation to be adjusted by individual member states. the UK granted royal assent to the Data Protection Act 2018 on 23rd May 2018, which contains equivalent regulations and protections as the GDPR.

After the first year of implementation of the GDPR over 200,000 cases have been reported. European data protection agencies have issued fines in excess of 55 million Euros for GDPR breaches since it was enforced last May, but this seems to be just the tip of the iceberg, thus making a strong possibility that enormous number of GDPR breaches are occurring but probably are yet going unreported. An assessment from the European Data Protection Board (EDPB) which is made up of regulators across the region, found that, in the first nine months, there were 206,326 cases reported under the new law from the supervisor authorities in 31 countries in the European Economic Area. One thing that has changed since the implementation of the GDPR is the massive increase in the reported number of incidents and more importantly that the companies have been reporting themselves to the data commissioner over the past year. The main emphasis under the GDPR Regulation is that companies must notify the regulators very quickly once the company losses any personal data. Consequently, of the breaches huge fines can be levied on the companies if they are found to have not done what they should have done to protect the personal data or specifically be able to display that they did all they could to clean up after the breach occurred in the first place.

Considering the developments all around the world, in terms of guidelines and regulations, specifically relating to the digital health, it is only right & more essential to emphasize the pressing need for India to have specific laws too for this area as practice carries on while laws don’t exist, which will result in exponential damage in the coming times.

About the author

Sapna Singh is a lawyer with years of experience in Telehealth law research. She possesses Diploma in Hospital Administration from India; Masters of Law in Intellectual Property Rights from US; Masters of Science in Telemedicine & ehealth from UK.

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Healthy Lives: Everyone, Everywhere

InnoHEALTH Magazine — Tue, 16 Apr 2019 09:22:43 +0000

Good health is the most precious thing anyone can have,” says Dr TedrosAdhanom Ghebreyesus, WHO Director-General. “When people are healthy, they can learn, work, and support themselves and their families. When they are sick, nothing else matters. Families and communities fall behind. That’s why WHO is so committed to ensuring good health for all.”

World Health Day

April 7th marks the birth anniversary of the World Health Organisation (WHO) and along with drives worldwide attention by spreading the message of the importance of global health each year.

Ranging from imperative issues such as food safety, diabetes, depressions, etc., this year the World Health Day embarks the mission of people-centered care irrespective of their financial hardships. The 2019 theme envisions the Universal Health Coverage (UHC), i.e., health for all. There are millions of people who have no access at all to healthcare. Majority of the populations are forced to choose between healthcare and other daily needs such as food, clothing, and shelter. In India, a lot of efforts need to be put in to ensure adequate medicines, affordable health policies, and financing strategies to enable everyone to get access to equal healthcare. “Universal” in UHC means “for all”, without discrimination, leaving no one behind, i.e. providing healthcare facilities which are

• Accessible
• Affordable
• Available
• Appropriate
• Adequate

Addressing the Financial Crisis

“Universal health coverage is also about ensuring access to essential quality care and financial protection,” says Dr. Mahjour. It aids in enhancing people’s health at large and increasing their life expectancy. Under this, many countries are protected from epidemics and the risk of hunger. This paves a way for new jobs, enhanced economic growth, and gender equality.

To make the phenomenon of Universal health coverage achievable globally, there should be concrete roadmaps which highlight the gaps and obstacles patients face in accessing proper healthcare. This can be done only when there are identified challenges, key actions and sustainable goals to be taken care of.

• There must be a holistic range of health and related services
• Quality care is a must
• There must be an end to discrimination and stigma
• The healthcare products and services should be affordable
• Sustainable investment in health is another prerequisite

Where India Stands – The New “Health-Y” Politics

The much-awaited general election will be held in India in April 2019 when the Indian voters will go to the polls. It is anticipated that whichever government comes into play will surely set a course for newer and better health policy.

Recent researches reveal an alarmingly rapid epidemiological transition. The occurrence of diseases such as cardiovascular diseases, diabetes, and cancer are rapidly on a rise. For instance, since 1990, the number of Indians with diabetes has increased from 26 million to approximately 65 million to date. The incidence of all cancers has increased by 28% between 1990 and 2016, with new cases of cancer emerging each year. India not only seems terribly engulfed in the swirling epidemic of non-communicable diseases, but it is also in the grip of a mental health emergency. The rate of global suicide deaths is speculated to be 1.1 times higher among women and 1.4 times higher among men than global averages in 2016.

It would be unfair if we highlight only the negative side of the picture. After many years of neglect, the Government of India has finally recognized and considered the perils of public discontent relating to health. Prime Minister Narendra Modi has initiated a new programme called Ayushman Bharat, which along with focusing on preventive health, emphasizes affordable health.

Ayushman Bharat majorly comprises two new flagship programmes. First, the creation of 1.5 lakh health and wellness centers across the whole country. These centers will primarily be responsible for providing primary healthcare facilities to provide health coverage for all. The second includes the National Health Protection Mission (NHPM)—a system of health insurance that intends to cover 500 million people. It covers secondary and tertiary care for the poorest and most vulnerable strata of society. These twin programmes together must help India improve access to quality health services and reduce out-of-pocket health expenditures.

Modi is the first Indian Prime Minister who has grasped the importance of health for Indian citizens and has prioritized universal health coverage as part of his political platform. “Modicare” as it is sometimes addressed to, can become a decisive issue in the upcoming general elections.

Way Forward for a Healthy Nation
Does Universal health Coverage still seem a distant goal in India!

The scant funding from the Central and state governments seems the root cause and the major hindrance in achieving UHC. The Central Government has recently announced a massive expansion of healthcare facilities.

Through its ambitious National Health Protection Scheme (NHPS), the Government of India provides a framework for universal health coverage in which it prioritizes healthcare delivery and its easy access. By reducing out-of-pocket payments, expanding service coverage, improving quality of services, and ultimately advancing UHC, countries and in particular, India with schemes like NHPS in place can transform the health of their people and bring drastic changes in society. As stated by WHO Director-General: “No one should have to choose between death and financial hardship. No one should have to choose between buying medicine and buying food.” UHC indeed is a way to go ahead.

About the author

Dr. Jasmeet Kaur is a Doctorate in Immunology and whenever she gets free time from the full-time job she loves to read and write about imperative issues in healthcare.

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National Strategic Plan for Elimination of Malaria

InnoHEALTH Magazine — Fri, 30 Nov 2018 06:17:45 +0000

National Strategic plan for the elimination of Malaria being implemented vigorously in India

Amid ongoing plans to eliminate malaria, experts have found the incidence of malaria in India is 0.66 cases per one thousand population last year.

Official sources say in the year 2017, reported malaria cases have declined by 23% as compared to 2016 in India.

As per the World Malaria Report 2017 of the World Health Organization (WHO), the estimated malaria cases from India are 87% in South East Asia region.

Malaria is mainly concentrated in the states of Chhattisgarh, Jharkhand, Meghalaya, Mizoram, Orissa, and Tripura because of the inaccessible terrain – many areas get cut off post-monsoon, the presence of efficient vectors – mosquito that transmits malaria and difficult terrain because of which malaria continues to be high in many pockets.

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Global Technical Strategy (2016-30) announced by WHO and adopted by World Health Assembly in May 2015 calls for malaria elimination by 2030.

According to the Minister of State (Health and Family Welfare) Ashwini Kumar, the Government has unveiled a plan to eliminate Malaria by 2030. The National Framework for Malaria Elimination (NFME) 2016-2030 document launched on 11th February 2016, lays out the vision, mission, broad principles and practices to achieve the target of malaria elimination by 2030 synchronizing with the Global Technical Strategy (GTS).

The Government has drafted National Strategic Plan for malaria elimination (2017-2020) wherein the country has been stratified based on the malaria burden into four categories – category 0 to category 3 and based on this the intervention of malaria control and prevention are being strengthened.

Interventions that are being strengthened are Early diagnosis and complete treatment; Case-based surveillance and rapid response; Integrated vector management; Indoor residual spray (IRS); Long-lasting insecticidal nets (LLINs)/ Insecticide-treated nets (ITNs); Larval source management (LSM); Epidemic preparedness and early response; Monitoring & Evaluation; Advocacy, coordination and partnerships; Behavior change communication (BCC) and Community mobilization and programme planning & management.

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5.2 Million Medical Errors in India

InnoHEALTH Magazine — Wed, 21 Nov 2018 04:56:32 +0000

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and the World Health Organization (WHO) has estimated that medical errors happen in 1 out of 10 patients every year globally but according to Harvard Study conducted by Prof. Jha revealed that 5.2 medical errors happen annually in India and among that, medication and hospital-acquired infection errors are the major ones.

To increase the quality of care, developed countries had already initiated incentive payment model to encourage and reward healthcare providers (hospitals, public health centers, school-based hospitals, and group practices) for delivering high-quality care.

Centre for Medicare and Medicaid Services, United States has developed value-based purchasing program rewarding the healthcare providers who had provided quality care to their patients.

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Similarly, in 2017 the Singapore Health Ministry started to focus on the quality of care. Healthcare system in India pays the provider for the quantity of care, not for quality care and has not initiated any policies with regards to the increase in quality of care.

Mr. Bhargav Dasgupta, Managing Director, and CEO of ICICI Lombard in a recent press release about Indian government increasing GDP for healthcare to 2.5 said, it is a good move and this spending can be used to initiate quality programs. To measure the quality of care, the government should implement Quality metric tools in the major areas of medical error namely, reduce medication and hospital-acquired infection.

The quality metric tool will help the Indian Health Ministry to assess whether the provider has delivered high-quality care. For example, to assess whether a hospital has delivered high-quality care in prescribing medication to the patient with upper respiratory tract infection, the provider should report how many patients are being prescribed with proper antibiotics – for how many days.

Suppose the first year if the provider proves that 100 patients were prescribed with proper antibiotics then the number of patients should increase to 10% each year and finally achieve 100% goal in the consecutive year. The government should reward the provider with the incentive for providing evidence of high-quality care. Once two major medical errors have been addressed and controlled, the government can use the same model to all the areas of medical error. Hence, this incentive program will eventually increase the quality of care and decrease the cost of healthcare. This incentive program should be initiated first in government hospitals, profit hospitals, and physician group practice. This will further attract more medical tourist to India due to the high quality of care.

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Vision on Blindness Cure Needs Aggressive Approach

InnoHEALTH Magazine — Thu, 19 Jul 2018 10:31:24 +0000

Despite current measures, blindness in the world is increasing by 1 to 2 million cases per year – the result is a 100% increase in world blindness by the year 2020 unless more aggressive measures are in place.
The World Health Organization (WHO) estimates that 80% of visual impairment is either preventable or curable with treatment. As of 2015, there were 940 million people with some degree of vision loss. 246 million had low vision and over 45 million were blind with 60% of these individuals living in China, India and Sub-Saharan Africa. Majority of people with poor vision reside in the developing world and are over the age of 50 years. Visual impairments have considerable economic costs both directly due to the cost of treatment and indirectly due to decreased ability to work.
Also Read: Artificial Retinas

India is home to over 8 million blind people, another 50 million have moderate to severe vision impairment. The loss of sight causes enormous human suffering for the affected individuals and their families. It also represents public health, social and economic problem for countries, especially the developing ones, where 9 out of 10 of the world’s blind live.
Visual impairment, also known as vision impairment or vision loss, is a decreased ability to see to a degree that causes problems not fixable by usual means. The term blindness is used for complete or nearly complete vision loss. Visual impairment may cause people difficulties with normal daily activities such as driving, reading, socializing and walking.
The most common causes of visual impairment globally are uncorrected refractive errors (43%), cataracts (33%), and glaucoma (2%). Refractive errors include nearsighted, farsighted, presbyopia and astigmatism. Cataracts are the most common cause of blindness. Other disorders that may cause visual problems include age-related macular degeneration, diabetic retinopathy, corneal clouding, childhood blindness, and a number of infections. Screening for vision problems in children may improve future vision and educational achievement.
According to Mr. J.P. Nadda, Minister of Health & Family Welfare, “The central government is committed, inter alia, to developing and strengthening the strategy of NPCB towards ‘Eye Health for All’ by way of preventing visual impairment through provisioning of comprehensive universal eyecare services and quality service deliveries”.
Mr. Ashwani Kumar Choubey, Minister of State for Health & Family Welfare says, “Despite greater awareness and policy interventions, blindness in the world is increasing phenomenally and according to WHO unless more aggressive measures are taken, there may be 100 percent increase in blindness by the year 2020. This is highly alarming & needs drastic wholesale measures”.
This calls for reducing the backlog of avoidable blindness through identification and treatment of curable blind at primary, secondary and tertiary levels, based on an assessment of the overall burden of visual impairment in the country.
Optometrists as the first point of contact for primary eye care services and equipped with the requisite knowledge and expertise, thus create a huge impact in preventing this avoidable blindness & vision impairment.
Mr. Santosh Kumar Gangwar, Minister of State, Labour & Employment says, “The traditional core of optometry has been the assessment of visual health and management strategies centered on spectacle lens and contact lens therapy. This core, however, has expanded greatly over the past century to include a number of other important services. Today’s optometry professionals are well educated and well trained to provide the full range of services thereby enhancing vision, protecting the health and preventing avoidable blindness due to refractive errors and visual impairment by over 80%”.
Mr. Ashok Siddharth, MP (Rajya Sabha) & Member Parliamentary Standing Committee on Health and Family Welfare noted that “Optometrists today provide approximately two-thirds of all eye care in the country and are prepared to meet the growing needs of the public”.
“The role of optometrists in tackling the problem of refractive error and visual impairment is important. Timely detection of refractive errors and their correction by spectacle can not only improve the child’s potential during the formative years but also prevent complications associated with uncorrected refractive error” said Dr. Promila Gupta, Director General of Health Services, Ministry of Health & Family Welfare.
The hard work and devotion of Indian optometrists within their profession and around their communities thus provide an invaluable service to millions of Indian citizens. Without their dedication, desire to serve the community and professionalism in delivering excellent eye care services; our fellow countrymen would not enjoy the optimal vision they have today.
In the backdrop of the above, Indian Optometric Association, the apex industry association representing approximately 12,000 Doctors of Optometry, optometry students, and paraoptometric assistants accessible to the common public.
Speaking on the occasion, Mr. Anil Tyagi, President, Indian Optometric Association said “AIOC has become synonymous with providing participants from across India & abroad, an excellent opportunity to share their research, experiences & optometry advancements. They sought to generate, from the conference, a better understanding of the role of optometry in eradicating the 80 percent avoidable blindness in India and other developing countries. The key to success would be making primary eye-care services easily accessible &economicaaly viable for a common public”
AIOC 2018 Organising Secretary, Dr. Subodh Dixit said: “the 37th AIOC 2018 conference spread over 16 interactive sessions & 10 workshops showcased over 75 prolific speakers, nearly 600 plus industry delegates & 20+ exhibitors; thus, offering exceptional value both as a traditional technical conference & a global networking forum”.
Dr. Rajeev Prasad, Conference Chairman, AIOC 2018 added that “the All India Optometry Conference (AIOC 2018) engaged collective experience & expertise of practitioners, optometrists, industry partners, academia, and technology organizations to discuss, deliberate, share & learn the best of practices and leadership traits”.

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